Verona-Cedar Grove Letter: Parent shares reality of colon cancer

My husband Ken and I remain Verona-Cedar Grove Times subscribers 15 years after relocating to Virginia Beach. As former long-time Cedar Grove residents, many in town are aware of our daughter’s recent ordeal with colon cancer. Dana was diagnosed with Stage two colon cancer at age 24, just two years after her tenure as a fit and active Middlebury College varsity field hockey player. Four years later, she thankfully remains healed — due in no small part to the decisive action of her team of Manhattan physicians. In honor of Colon Cancer month, I would like to bring attention to the startling reality that incidence and mortality rates for colorectal cancer (CRC) are steadily decreasing among all age groups older than 50 and increasing significantly in younger individuals. Many are aware that CRC remains the third most common and second most lethal cancer, yet few realize that more than one-tenth of cases (11 percent of colon cancers and 18 percent of rectal cancers) occur in patients younger than age 50. It’s alarming enough that current Mayo Clinic grant research on this subject chooses the attention-grabbing "Call to Action" in its subject line. Make no mistake: The face of colorectal cancer is indeed changing.

What explains this trend and why are young onset CRCs more likely to present at advanced stages (50 to 60 percent diagnosed at Stage three or four)? While space does not allow for all possibilities to be considered here, the following is certain. A segment of young adults exhibit many of the same risk factor lifestyles as their corresponding elders; namely, obesity, physical inactivity, moderate to heavy alcohol consumption, smoking, stress and unfavorable dietary patterns. However, their elders (at least those insured) qualify for preventive, no-cost screenings beginning at age 50. (My present home state of Virginia ranked 10th nationally last year for preventive CRC screenings, approaching 70 percent compliance.) In contrast, screening use is very limited for young adults. Since only 22 percent of early onset CRCs under age 40 are due to heredity factors, that leaves almost 80 percent who must rely on symptoms and/or primary doctor education for timely diagnosis. And therein lies the problem.

Teenagers and young adults are not the only ones for whom key symptoms may go unrecognized or be ignored, but too often when they do share, primary care doctors allow a low suspicion of cancer to cloud their judgment. Time and time again in our national advocacy efforts, Dana and I hear story after heart-wrenching story of symptomatic teens and young adults who did not get the thorough evaluation and diagnostic workup needed to effectively establish CRC at an earlier stage. Young anemic patients are not even questioned about possible rectal bleeding as would someone 20 years their elder; reported rectal bleeding is summarily dismissed as hemorrhoid-induced; unintentional weight loss does not trigger the same alarm as that of an older patient; abdominal pain and/or changes in bowel habits are attributed to colitis, IBS or stress. (Some young, advanced CRC patients we have encountered were actually prescribed anti-depressants.) Too often a colonoscopy is a test of last resort for this age group, when timely referral to a GI doctor and prompt endoscopic work-ups would ensure earlier detection and increase survival rates.

As discussion elevates on lowering the CRC screening age for some segment of the average-risk population, primary care physicians will continue to have an important opportunity to identify high-risk young individuals for screening, and to promptly evaluate CRC symptoms in those average-risk young adults who present. Parents also have a critical role in educating their teenage and young adult children on symptoms and healthy lifestyle choices. And in their dual role of health advocate, parents can help ensure that their children’s symptoms elicit the timely attention and workup they deserve, acting in partnership with their children’s physicians.